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‘Easy to use, Easy to buy’: A Q&A with Friday Health Plans

Posted on by Ideon

In the past decade, several health insurance carriers have entered the individual and employer-sponsored markets, bringing innovative products and consumer-first digital experiences in a bid to compete with legacy carriers. One such entry is Friday Health Plans, a Colorado-based company launched in 2015 to serve the individual and small group markets. As Friday has expanded from a single-state carrier to a rapidly growing multi-state firm with $186 million in venture capital funding, digital technology has been a driving force behind its growth. 

To learn more about the company’s growth strategy, Ideon spoke with Lisa Kwiecien, Friday’s director of channel development. The interview has been condensed and edited for clarity.

IDEON: What is Friday’s key differentiator?

KWIECIEN: We create health plans that are good value, easy to buy, and easy to use. We always put the consumer first, which is apparent in our plan designs. 

How does technology help Friday compete against more established, national health plans?

Because we concentrate on individuals, families, and small groups, we have fewer plan designs, which means that our technology can be more focused and efficient. Tech helps make our plans easy to administer, straightforward to buy, and effortless to understand. That’s true for brokers, employers, and most especially consumers.

How so?

We’ve invested in technology across the company—in our app, in our telehealth function, in customer support. We’ve enhanced our ability to communicate with members, to help them access their ID cards digitally, to understand their deductibles and other plan details. They can also use our app to search for providers. We knew we had to be aligned with today’s consumer expectations generally.

Friday Health Plans recently started working with Ideon. Can you talk about that? 

We work with Ideon in two ways. We share our plan and rate information with Ideon, which then distributes that data to third-party quoting platforms used by brokers, employers, and consumers. And we use Ideon to connect with benefits platforms [e.g., Rippling, GoCo, Decisely, Sequoia, Gusto], which helps us streamline digital enrollment and member management. We know we have great products and competitive rates, but we wanted to make the enrollment process more efficient for small businesses and for brokers. We needed to improve connectivity with today’s benefits ecosystem.

Why is connectivity with respect to brokers so important? 

We pride ourselves on being a broker-friendly carrier. Many decisions by brokers are made because of convenience, so we want to make our products and technology as convenient as possible. We started to search for different ways that we can automate enrollment, because historically it’s been a super manual process to submit member and group enrollment information in the small group market. There’s a lot of back-and-forth. It’s inefficient. And often it still involves a lot of paper. Ideally, we want it so that brokers can digitally manage all transactions, submitting enrollments on their preferred platform so that we’re not working on different CSV files or PDFs, etc. 

Why does uniformity like that matter?

For us, receiving a consistent file format from all these platforms improves our efficiency and accuracy, enabling us to seamlessly process incoming enrollments and member changes. And when we minimize errors, everything happens faster, creating a streamlined process. Members get their ID cards sooner, brokers have fewer fires to put out. We’re always working to build a streamlined process that flows smoother than it does today.

Does having better digital connectivity with benefits platforms factor into Friday’s growth plans?

Absolutely. It’s about scalability. When we anticipate our expansion into new markets and new states, we want to make sure that we have the technology in place to scale effectively. Enhancing our connectivity with benefits administration platforms is a prerequisite for scaling our business. That’s one reason why we’re working with Ideon.

Final question: Friday, which is a member of the HRA Council, supports Individual Coverage Health Reimbursement Arrangements (ICHRAs). How do ICHRAs fit into your company’s strategy?

We’re always thinking about how to improve affordability and optionality to employers and employees. There are a lot of reasons why ICHRAs might appeal to a small employer—e.g., cost predictability, class options—and ICHRA gives an employee more plan choices through the individual market than does a traditional small-group offering. They’re also tax-free and transportable. Our CEO, Sal Gentile, sees ICHRAs as a growth opportunity as they become more prevalent in the next few years. 

Thanks so much for your time and candor, Lisa.

My pleasure.

To learn how benefits platforms can connect with Friday Health Plans, or for information about Ideon’s solutions for carriers, please reach out to support@ideonapi.com.

Employee Spotlight: Kashika Whitelaw

Posted on by Ideon

At Ideon, we’re proud to have such a talented, diverse team leading the charge for a better and more connected health insurance and employee benefits industry. Our ongoing Employee Spotlight series showcases the people behind our product and unveils what life is like at Ideon. Next up… Kashika Whitelaw, a key member of our Omaha-based enrollments team.

 

Name: Kashika Whitelaw

Title: Quality Assurance Analyst, Enrollments

Location: Omaha, Nebraska

Work

How long have you worked at Ideon?

One year and two months 

How would you describe Ideon’s culture?

The company as a whole has built a positive culture. Our work is challenging, but at the same time, it’s refreshing being part of such a progressive, flexible, inclusive, and collaborative company where everyone works together toward a common mission.

What do you like most about your job and working at Ideon?

Constantly learning and being inspired by the openness of creativity and innovation. 

What’s your day-to-day like on Ideon’s enrollment operations team?

I provide assistance to our tech partners ensuring member management data is processed as seamlessly and effectively as possible. I’m also currently involved in developing Ideon’s Enrollments Operations Quality Assurance (QA) department by creating processes, documentation, workflows and training new team members. 

How was the onboarding process joining Ideon amid a global pandemic? Was it challenging to get to know your teammates while working remotely?

Onboarding was user-friendly and straightforward for me—our People Team laid out exactly what needed to be done and they were very responsive when I had questions. My computer, applications, and credentials were perfectly set for my first day.

Life

Favorite activities when you’re not working?

Dance, exercise, home decor shopping, work on side projects, and binge-watch shows (Grey’s Anatomy is my favorite).

Favorite place you’ve traveled?

Turks and Caicos 

Interesting fact about yourself…. Go!

My daughter and I make our own natural hair products and participate in double dutch tournaments locally.

 

Interested in joining our team? Check out Ideon’s careers page.

How third-party quoting platforms can drive better analytics and more sales for health insurance carriers

Posted on by Ideon
By Matt Leonard, Ideon’s Vice President of Carrier Relations

In recent years, brokers have flocked to third-party services to quote health insurance plans from multiple carriers. As a result, most carriers wanted to immediately tap into this new, growing distribution channel. They were quick to share rates and product information with external partners, making the downstream quoting process easy and accurate for brokers assembling employer proposals.

But not all carriers bought in. Holdouts chose to keep rates in-house, forcing brokers to obtain quotes directly from them. Their chief concern: a perceived black hole of visibility and analytics. Specifically, carriers worried they’d lose access to valuable information typically gleaned when brokers quoted plans via carrier websites and portals—e.g., which brokers sold what products (and where), what employer groups were shopping for new policies, etc.

Today, with a majority of health insurance carriers having made their plans and rates available to third-party quoting platforms, we can now see whether those early fears were justified.

Short answer: Carriers that embraced the “platform revolution” are being rewarded with a stream of high-quality data that can drive advanced analytics and turbocharge sales operations. In fact, their visibility into quoting activity on platforms is not all that different compared to if quotes are prepared on carrier websites. It’s truly a win-win—i.e., modern distribution combined with valuable insights.

Meanwhile, carriers that are not distributing their rates continue to miss out in two ways: limited distribution to digital sales channels and zero visibility into how—and if—their products are being quoted externally.

To understand why, let’s examine two scenarios.

  1. Carrier relies entirely on in-house website or portal for quoting

    In the past, brokers logged on to each carrier’s website to get the quotes they needed to assemble a client proposal. That’s a lot of busy work for the broker, but it gave the carrier critical information. Location data, insights on which brokers are quoting which plans, and information about group sizes and quote-to-close ratios are all part of the typical carrier analytics package. And when they see quotes generated for potentially lucrative accounts, the carriers can assign sales representatives to help brokers to win the business.

    This may seem like an appealing option to carriers that want full control over where their products are quoted. And, understandably, they crave these in-depth analytics. But this mindset—control over distribution—is built upon a false premise. Third-party quoting platforms still add the plan and rate information of non-participating carriers, mainly by tracking down public filings and other sources.

    The difference? The data could well be incomplete or out-of-date, risking the possibility of inaccurate quotes appearing on client proposals. And carriers receive no information at all about how well their products are doing on downstream platforms and no leads on deals in progress.

  2. Carrier engages with today’s platform ecosystem

    Today, nearly all brokers use quoting platforms to save time compiling rates from multiple carriers and building proposals. Most carriers understand this reality and have reacted accordingly. These carriers distribute their product information to quoting platforms to ensure rates and plans are represented accurately.

    At the same time, the participating carriers have access to a precise record of every quote issued, often specifying the individual broker, the employer group, and more.

    Carriers can use this data to build sophisticated analytics that can help optimize the effectiveness of their marketing campaigns and commission programs. For example, they can calculate the quote-to-close ratio across different brokers, client types, geographic areas, and commission rates. Carriers are also feeding the data they get from quoting platforms directly into their CRM systems. That way their sales team can monitor how well they are being represented by each broker in the market and react quickly to opportunities.

 

Today, most carriers clearly see the two main advantages in working with platforms: distribution and visibility. The good news for those only now seeing the light is that they can catch up quickly, i.e., they need not build relationships with platforms from scratch. Middleware vendors, like Ideon, act as one-to-many distribution partners for carriers, accepting their plan data in any format and sharing it throughout today’s modern quoting ecosystem. And because a middleware partner pulls in quote activity and analytics from many downstream platforms, carriers get all the visibility they need to make informed decisions.

What are the opportunities that non-participating carriers are missing? Consider the recent experience of one new Ideon customer, a major health plan in the South, that recently started using our solutions to publish their plan information to quoting platforms. Until then, this carrier had assumed that most brokers were looking up their rates on their website. They were shocked when they looked at the analytics we delivered to find that brokers, using third-party platforms, were quoting their plans 600+ times per month. Before Ideon, the carrier had zero insight into these potential new business opportunities.

Now that’s a black hole to be concerned about. Contact us to learn more!

BenAdmin Platforms Beware: Three potential data quality pitfalls—and how to avoid them

Posted on by Zach Wallens
By Zach Wallens, Ideon’s Communications Manager

The busy season is upon us yet again. And, yet again, health and benefits industry stakeholders are preparing for a mostly digital open-enrollment season in year two of the Covid-19 pandemic. Brokers are quoting the latest benefits products and formulating client proposals; employers are debating whether to stay the course or offer different health insurance and benefits in the coming year; and employees are familiarizing themselves with the digital tools that will guide their selections.

The focus for benefits administration (BenAdmin) platforms and other BenAdmin providers, as usual, is delivering high-level customer experiences through technology that eases the enrollment process rather than inhibits it. But given this emphasis on customer experience, there is another essential consideration for benefits technology vendors: data quality. Even the most user-friendly, feature-rich benefits software can earn a reputation as a front-end failure if data accuracy and quality are problematic during open enrollment.

The good news: BenAdmins have tools at their disposal to rectify—or, at least, minimize—data quality issues. 

The better news: BenAdmins need not rebuild their data infrastructure from the ground up to significantly improve quality. 

Rather, BenAdmins can lower their risk of data snafus by working with specialized vendors, whose solutions improve the speed and accuracy with which enrollment-related data is sent and received. With that in mind, here are three potential hazard areas that BenAdmins should keep an eye on—and how to avoid them.

1. Product-specific data. 

Employees need… 

  • An easy, streamlined way to review specific criteria they deem most important among the health plans offered by their employer. 
  • Confidence that they understand which plans meet their criteria, and will fit their budget. 
  • Help navigating the complexities of choosing not only health insurance, but also ancillary products (vision, dental, life and disability) that best suit their needs. 

API Middleware solutions can… 

  • Ensure data accuracy remains king, by aggregating plan and provider data directly from health plans and ancillary carriers. In doing so, they help BenAdmins maintain fidelity to their plan library and provider directory—plus the thousands of data points associated with each plan—without risking damage to employees’ health, financial well-being and goodwill. 
  • Shift the burden of data accuracy to the API vendor, enabling BenAdmins to confidently display product-specific information without fear of inadvertently misleading employees.

The Takeaway: The pathway to choosing the most appropriate health plan and ancillary benefits begins with employees having access to accurate, in-depth, comparable information about their options. Low-quality or outdated data, for example, can lead an employee into thinking that a plan covers their primary care physician, only to learn, post-enrollment, that the doctor recently dropped out-of-network. In third-party APIs, UX-focused BenAdmins have found a secret sauce for maintaining quality data. 

2. Group and member-level enrollment data. 

Employees need… 

  • Confidence that group and member information won’t fall prey to human error as it is manually keyed into enrollment apps. 
  • A seamless, delay-free receipt of their insurance card and, ultimately, use of their health insurance and benefits.

API Middleware solutions can… 

  • Connect carriers and BenAdmins and exchange accurate data between them (in fact, that’s their specialty). 
  • Enhance the quality of enrollment data by validating whether the submitted information meets carrier-defined business rules and other criteria, before the data even reaches the carrier. 
  • Allow BenAdmins to quickly and accurately identify and revise data issues, minimizing the chance of a lengthy enrollment delay for an employee.

The Takeaway: There will always be some risk of typos and other mistakes in enrollment data transferred from BenAdmins to carriers and benefits providers. After all, enrollment still involves some degree of human data entry. But for BenAdmins, the objective should be minimizing the amount of errors that reach carrier systems. API middleware partners can do that. 

3. Plan, class, and division mapping. 

Employees need… 

  • Confidence they will get enrolled in the correct plans with the correct carriers
  • BenAdmins with streamlined operations based on correct plan maps.

API Middleware solutions can… 

  • Enhance BenAdmins’ mapping capability to ensure groups and employees are enrolled in the right plans for the right coverage periods. 
  • Offer unique visibility into what’s under the hood at carriers and BenAdmins, making it easier to configure complex group setups when an employer has multiple plans, classes, and divisions.

The Takeaway: As with many things related to health insurance and benefits, what should be simple often is not. Where a group or employee may believe that they are enrolled in “Carrier PPO 123,” the carrier might identify that plan, internally, as “Carrier PPO NY ABC.” Or the same plan could have different IDs depending on the state or employee classification. This can generate massive confusion and even instances where employees or groups get enrolled in the wrong plan. Some larger businesses with numerous classes and divisions of employees might offer upwards of, say, 10 medical plans and several ancillary plans. Carrier-connectivity partners can help BenAdmin vendors relieve this pressure. 

And that’s no small thing. At a time when fully-digital, employee-facing enrollment capabilities are nearly universal, maintaining highly accurate data can be a true differentiator. Thankfully, there are partners, such as Ideon, that have considerable experience helping BenAdmins enhance their data quality without much development effort and investment.

 

Interested in learning more about middleware solutions? Download our guide on outsourcing carrier connectivity.

Employee Spotlight: Tom Aguilar

Posted on by Ideon

At Ideon, we’re proud to have such a talented, diverse team leading the charge for a better and more connected health insurance and employee benefits industry. Our ongoing Employee Spotlight series showcases the people behind our product and unveils what life is like at Ideon. Next up… our long-time software engineer, Tom Aguilar.

 

Name: Tom Aguilar

Department: Engineering

Title: Software Engineer

Location: New York

Work

How long have you worked at Ideon?

Five and a half years. I was one of the earlier employees, No. 14 to be exact!

So you’ve had a front-row seat to Ideon’s transition from a small startup to the well-funded, nearly 100-person company it is today. What’s that experience been like for you?

It’s been a great learning experience over the years. When I started, everyone wore many hats, as is common early on. We were discovering what worked and didn’t. We’ve learned quite a bit from those early days, and we now have a more established process and team structures to fully support our mission.

You started your Ideon career on the data operations team. How was the transition to the engineering team?

When I first joined, I was part of the data operations team, figuring out how our health insurance benefit and rate data should be standardized and sourced into our system. At some point, it became clear that what we were doing was closely tied to our engineering team’s effort to build out our APIs and expose the data to customers. With support from the engineering team, I transitioned from a more data-science role to software engineering, which was a fun and engaging way to learn. And I have a unique perspective that I get to share. I can help new Ideon engineers get up to speed and more deeply understand how the rest of the company functions.

What attracted you to Ideon’s mission?

I went to a public health school so I was drawn to the mission of improving access and efficiency in the healthcare system. I enjoy getting the opportunity to work for a company looking to make the system work better for everybody. 

What do you enjoy about Ideon’s company culture?

We have a really strong and diverse team that I get to work with every day. I enjoy the good balance of independent work and collaboration on the engineering side. 

What do you like most about your job and working at Ideon?

I love that I get to take a deep dive into the insurance industry’s challenges, as my workday is full of solving technical problems that impact how millions of Americans access and enroll in benefits.

Tell us about your day-to-day as a member of the engineering team?

My day starts at “stand-up”—our daily morning meeting—going through the tasks I’m currently working on and any blockers that I have run into. Then from there, I’m focused on getting features out to our customers or on improving the internal tooling for our operations team.

Life

Favorite activity when you’re not working?

Drinking natural wines and playing records.

Favorite place you’ve traveled?

Japan.

 

Interested in joining our team? Check out Ideon’s careers page.

Seven ways benefit administration platforms can provide year-round value

Posted on by Zach Wallens

Most benefits administration (BenAdmin) platforms only have genuine access to employees during open enrollment. This small window of engagement is frustrating to BenAdmin leaders, but it need not be. That’s because they already have the building blocks necessary for creating year-round member interactions: existing relationships with employers and information about their employees. 

By smartly leveraging those relationships and that data, BenAdmin platforms can become a 24/7/365 gateway to the myriad of providers of health, retirement, and other programs an employer offers. Not only will that enhance the value BenAdmins deliver to employers, it will further differentiate them from their competition as well. 

Here is just a sampling of the enhanced services that can turn BenAdmin platforms into year-round destinations:

Centralized Portals for single point of access to HSA, FSA, HRA, 401k and other accounts. With these, employees can log onto a BenAdmin site or app and access to all of their health plans, retirement, and flexible spending information. 

Accumulators. A single up-to-date view of the important running totals from all member’s benefit plans, such as deductibles, out-of-pocket maximums, and flexible spending account (FSA) balances.

Provider Search. One interface to find any sort of provider. Since the BenAdmin knows the plans in which each employee is enrolled, it can limit the display of providers to those that are in-network.

Cost Estimator. A tool that enables a member to enter a procedure or drug and see their out-of-pocket cost under their plan. This tool could also let members compare their effective costs at different hospitals, using the price transparency disclosures that the federal government has mandated. 

Benefits Marketplace. A year-round array of voluntary benefits, programs and offers available through the employer such as gym memberships, pet insurance, identity protection, and student loan assistance. The most relevant offers can be surfaced when members get married, have children or experience other qualifying life events.

Healthcare Concierge. Many BenAdmin providers offer sophisticated decision support to help members select plans. This assistance can be extended year-round in regards to selecting providers, lowering costs, and even booking appointments. Concierge services can be offered via human support, automated bots, or in combination.

Wellness Programs.  There are myriad ways to offer members the information, support, and encouragement to make healthier choices about eating, exercising, stopping smoking, managing chronic conditions, and dealing with mental health. These can deploy tools including self-assessments, coaching, gamification, rewards, and integration with mobile devices. 

Concierge and wellness programs can involve significant investments in content and support staff. BenAdmin providers, accordingly, may look to partners for these services rather than building them in-house. But all the other services on this list are essentially extensions of the capabilities that BenAdmins already have—connecting data from benefit providers, employers, and employees. Still, by using this information to offer convenience, utility, and insights, BenAdmin providers can engage members and prove value to employers 12 months of the year.

We’ve always been committed to data security. Now we have the audit to prove it.

Posted on by Dan Langevin
**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

By Michael W. Levin, co-founder and CEO of Vericred.

Our overarching goal at Vericred has always been to improve the experience of buying and using health insurance, which more than anything means getting the right information to the right people and places at the right time. But even as we’ve forged new paths in digital connectivity in pursuit of this goal we have never lost sight of the profound responsibility our mission entails. Trusted with highly sensitive information about millions of people—including medical, identity and employment data—we have from our earliest days felt obligated to do all we can to ensure that our systems are as secure as possible.

Never an easy task, our efforts to protect the data we handle has grown more challenging every day, as increasingly devious cybercriminals launch the kinds of attacks that now regularly make news. But in recent years and months we have invested thousands of person-hours in both the “hardening” of our information technology and the tightening of procedures in every aspect of our business. 

The result of this often burdensome work is the internal certainty that in this realm, too, we are setting industry standards and, now, important external confirmation of that belief. Vericred’s data security initiatives, I can report, were recently validated by a new System and Organization Controls 2 Type II (SOC 2) examination for security, availability, and confidentiality, conducted by a public accounting firm specializing in information-security audits.

The American Institute of Certified Public Accountants (AICPA) developed the SOC 2 process to reassure customers of cloud computing and other digital services that their information is secure. As with an accounting audit, in which an independent firm examines a company’s procedures before issuing an opinion on the accuracy of that company’s financial statements, a positive SOC 2 report reflects an auditor’s confirmation that a company meets the AICPA’s Trust Services Criteria. 

Vericred has always aspired to the highest standards of transparency and integrity. From our earliest days, we had our financial statements audited, a process young private companies rarely undertake. And once we began to build our enrollment and member management API, we knew we had to invest in state-of-the-art information security. Health insurance carriers, benefit administration platforms, and employers would be trusting us to safeguard personally identifiable information (PII) and protected health information (PHI) of plan members.

Frankly, meeting the standards for the SOC 2 report was more involved—and invasive—than we expected. In addition to investing the resources necessary to harden our technology, we also instituted background checks for employees, added access controls for our facilities, and installed software to track what employees do on their work-issued computers. We have imposed a clean-desk policy to ensure that no confidential information ever lingers on a Post-it note or in an unlocked file. If we were to ever experience a breach, we have a detailed contingency plan, not to mention forensic experts on retainer to minimize any potential damage. 

If this all seems a bit over the top, maybe even obsessive, that’s largely the point. We’ve gone to such great lengths—and will continue to do so¸— both because it’s the right thing to do and because we want to be the model on security in our industry as with all other aspects of our operations. Over the years we’ve played a central role in building a community of carriers and technology companies, coming together to develop an interconnected ecosystem of powerful health insurance and benefits applications. Security needs to be part of this conversation, a top-of-the agenda item. 

Because a breach of the weakest link in the chain can undermine the credibility of every participant.

At Vericred, we want to help facilitate this mindset and support the industry as it strives to keep moving forward safely. Reach out to us with any questions and ideas at info@ideonapi.com.

Build vs. Buy: The Case for Enhancing Carrier Connectivity to Improve Enrollment Experiences

Posted on by Zach Wallens
By Zach Wallens, Communications Manager at Ideon

One-stop-shop HR and benefits administration (BenAdmin) platforms, which integrate all elements of the employee experience into a centralized system, are the future of the benefits industry. From health insurance and dental coverage to telehealth and gym memberships, those BenAdmins that offer the most-popular employee benefits on one platform will boast the best user experience and, as a result, a significant advantage over rivals. In fact, some forward-thinking BenAdmins are already preparing for this all-in-one future, laying a foundation to scale aggressively and add new benefits at a moment’s notice.

But this trend raises an important question: How, from a technical standpoint, will BenAdmins add all of these benefits products—from numerous insurance carriers and other providers—to their platforms?

The answer, as most BenAdmin executives know, is digital connectivity. BenAdmin platforms have long identified connectivity with carriers as a technological necessity—and competitive differentiator—for success in today’s digital-first age. Connectivity enables BenAdmins to present up-to-date product information, enroll employees in benefits digitally, and transfer group and employee-specific information to carriers and other providers. It is a pivotal component of any modern BenAdmin experience.

But while digital connectivity is universally accepted as integral to any tech-forward BenAdmin’s UX strategy, a consensus has yet to develop on the issue of building or buying a solution for developing and maintaining carrier connections. Many BenAdmins elected to utilize their existing technology team to build integrations to carrier systems because this was, until recently, their only option.

This go-it-alone “build” approach, however, has been technically and operationally challenging for BenAdmins. Establishing and sustaining relationships with hundreds of carriers and providers—each with unique systems and formats to which BenAdmins have had to conform—is a process that is both time-consuming and labor-intensive. Moreover, integrating to each carrier’s core systems, one by one, involves tremendous development resources.

These drawbacks are prompting many BenAdmins to consider a new digital connectivity strategy: the “buy” approach. Indeed, a growing number have determined that buying connectivity on a mass scale, through a carrier connectivity partner such as Ideon, is a more effective use of resources than building those bridges themselves.

In this scenario, BenAdmins integrate with a single partner’s API, and it’s that partner’s responsibility to manage the connections and exchange of data—often in real time—with carriers and benefit providers.

These BenAdmins are outsourcing carrier connectivity to specialists in just that skill, resulting in massive efficiency gains, a quicker path to scalability, and better experiences for end users—employers, HR teams, and employees. Such forward-thinking benefits platforms have decided that it makes more business sense to invest in a turnkey solution that is built, managed and regularly improved by industry-specific digital connectivity experts than to devote time, money and labor to create multiple carrier integrations themselves.

Instead, these BenAdmins are taking the savings achieved from outsourcing connectivity and investing them in the development of improved experiences for their customers’ employees. Data-driven plan selection, personalized decision support, integrated telehealth services, and robust ancillary offerings are just a few of the tech-enabled experiences that employees expect from their BenAdmin. These are features that require ongoing iteration and improvement, and represent far better destinations for operational capital.

Buying is the new frontier of BenAdmin-to-Carrier connectivity, a forward-facing reallocation of resources that goes a long way towards enhancing their competitive advantage.

Arguing API vs EDI is Missing the Point

Posted on by Dan Langevin
By Dan Langevin, Ideon co-founder and CTO

The evidence is in: APIs are the future. Across industries—in travel, healthcare, retail, marketing, hospitality, etc.—Application Programming Interfaces are the superior technology for real-time data exchange in complex digital ecosystems.  

That’s no less the case in health insurance and employee benefits, industries for which it is essential that carriers, brokers, employers, and InsurTech companies be able to exchange accurate and up-to-date information that provides members (not to mention those brokers and employers) with the seamless digital experiences they’ve come to expect.

In fact, carrier executives today recognize that they must develop and deploy APIs for enrollment and eligibility or risk being left behind. 

But if APIs are the future, the present is still dominated by EDI—Electronic Data Interchange—and migrating to the former from the latter will take many years and untold millions of dollars. Recognizing this, some carriers are trying to bolt an API onto their existing legacy technology. But this process can also take several years and cost millions of dollars—and still may not provide InsurTech platforms what they need most: real-time access to carrier systems with dependable data quality.

Missing in too many calculations around this issue is the fact that there’s a way to achieve API-like, near real-time synchrony and high data quality today, through EDI: Ideon’s infrastructure solution, which puts an API “wrapper” around EDI. This hybrid approach allows carriers to save money and deliver higher quality service to brokers, employers and plan participants now—and build APIs when they are ready.

To understand why a hybrid approach that incorporates EDI and APIs is best, for now, it helps to recall the evolution of the technologies that carriers deployed to manage members.

In the 1990s, the industry began to adopt an electronic method for brokers and employers to submit enrollment data through BenAdmins to carriers: EDI. But if EDI is a fine format for eligibility and demographic information, it is limited. In particular, EDI is asynchronous—i.e., a one-way transfer of information—so errors aren’t detected until after the file is submitted and an exception report is returned to the sender. 

Moreover, the way the industry implemented EDI created as many problems as it solved. Each carrier developed its own EDI variant, requiring extra work from any broker, employer or technology company that needs to communicate with multiple carriers. Each carrier also has its own internal system for associating participants with plans, rates, networks and other details. These labels often don’t correspond to the way employers name plan options and describe them to workers, so the carriers needed another army, analysts, to clean up the data.

This resulted in two nettlesome consequences. First, because it takes time to review these EDI files, carriers limited how frequently they would accept them (generally, no more often than weekly). This gave rise to a two-week (or more) round trip, which contributed to poor experiences for employers, employees and brokers. For example, while an employee could use an HR app to, say, add a newborn dependent, they’d still have to wait two weeks for confirmation that the change was made correctly.

The second unfortunate consequence was that many carriers chose not to use EDI for small groups because they didn’t want costly analysts working on less significant accounts. So, for smaller groups, carriers asked brokers to enter enrollment data through broker portals. But if this sometimes reduced operating costs, it was—and is still—prone to errors.

Small wonder, then, that modern InsurTechs would prefer carriers to adopt APIs, which are, after all, how computer systems built this century communicate: Their developers know how to use APIs, and have myriad tools to speed their deployment and maintain security. For the BenAdmins, two aspects of APIs are critical:

  1. Bidirectional, transactional connections. That is, real-time conversations vs. the one-way lagged transfers of information of EDI. This  means that when an employee inputs a new baby through an InsurTech app, the API will transmit the name, birthdate and other information and receive near-immediate confirmation that the dependent has been added to the policy.
  2. Higher data quality. The real-time data exchange of APIs enables errors to be identified and addressed quickly. For example, if the new parent mistypes a social security number, the carrier API will flag the error immediately, allowing the employee to correct the information. 

So, of course, carriers should move from EDI to APIs … when they are ready. 

The problem is that they cannot do it as quickly or effectively as some in our business would imagine. A new API, by itself, won’t speed up the rest of the carriers’ electronic workflow. Their core systems still rely on mainframe technology that updates overnight and can’t support real-time changes. And there is a lot of hard work to do to automate the cleanup of enrollment data and the assigning of accurate product codes.

What’s more, APIs typically take years to develop at costs rising into the millions … and the carriers have to do all this with IT budgets already stretched just keeping up with ever-increasing regulatory demands. It’s why we’re in this situation: There has always been a more pressing issue than building eligibility APIs or replacing core systems. 

Still, brokers, employers and members expect fast, accurate and convenient access to all their coverage information. Which means that carriers disappoint them at their own peril. So what’s the industry to do? 

Embrace middleware, which solves all of the above problems and gives carriers the time they need to transition to APIs fully and most advantageously. At Ideon, we start with the premise that not only can we work with the EDI systems that carriers have, now and as they evolve, but elevate those systems to the benefit of both InsurTechs and carriers. By doing so, we give BenAdmin and other InsurTech companies the APIs they yearn for, and the carriers the clean data they need. Importantly, these APIs are consistent across carriers and lines of coverage for the functions we enable. This imparts significant leverage to these technology companies.  

How do we elevate EDI?  We build into these APIs each carrier’s business rules and validations. That enables synchronous responses to errors that may exist in their submission; errors that would have otherwise been transmitted to the carrier and taken a week to come back to them through a traditional EDI connection. These validations ensure that the EDI files we send to the carrier have fewer errors. As they spend less money to clean up EDI data, carriers become willing to accept EDI files more frequently (sometimes daily) and from smaller groups.

We also facilitate the exchange of data back from non-API carriers. For example, we ingest group structures and censuses from carriers regardless of how they are able to deliver these data (e.g., files, email, API, etc). Then we normalize this data, structuring and delivering it through an API to our InsurTech partners. Such data is used for group installation and reconciliation. This functionality eliminates what has historically been another set of manual tasks.

Taken together, our hybrid approach delivers 80% of what a true end-to-end API-to-API solution would. Again, we are not arguing against carriers building APIs. Quite the opposite. In fact, we are often asked to be thought partners as to the sequencing and structure of those APIs, and happily so. But we are saying that middleware is a solution that works very well today, leveraging EDI while addressing most of its shortcomings, thus allowing carriers room to develop APIs when they are ready.

And for those who doubt that middleware that incorporates legacy EDI technology can support modern BenAdmin systems, we offer this quick review:

  • Connected, virtually real-time experiences: ✅
  • Data quality: ✅ 
  • Leveraging existing technology and infrastructure: ✅

Over the coming months we will talk more about  a number of the areas touched on above. In the meantime, if you’re interested in our approach to simplifying the exchange of health insurance and employee benefits data, reach out to sales@ideonapi.com

Opportunity Awaits BenAdmins that support ICHRAs

Posted on by Ideon

By now, Individual Coverage Health Reimbursement Arrangements (ICHRAs) are no secret. Emerging only two years ago as an obscure addition to federal health insurance regulation, ICHRAs are now among the hottest topics in employer-sponsored benefits. But any significant employer shift to ICHRAs will require answer to a pair of important questions:

  • Is there an ICHRA role for benefits administration (BenAdmin) platforms?
  • If so, what exactly is it?

We can begin to answer both by examining the motivation for companies large and small  to migrate to ICHRAs. For small companies, ICHRAs are often a way to do something as an alternative to not offering employer sponsored health insurance. In fact, 70% of the small employers (<50 employees) offering an ICHRA today are contributing to their employees’ health insurance for the first time, according to Take Command Health. ICHRAs also allow small employers to get out of the often-burdensome benefits administration business. So, at the end of the day, there may be very little opportunity for BenAdmins in ICHRA-based small employers. 

Large employers, however, are another thing.

There are several reasons why large employers might adopt ICHRAs—but getting out of the benefits administration business is not one of them. First, a feature of ICHRAs is that they allow employers to move classes of employees to ICHRAs while keeping others on their existing group health plans. This provides more choice—and therefore a better benefit experience—to certain classes of employees. The last thing such employers want is to undermine a better insurance experience with a lesser benefits administration experience. These employers will very much want their BenAdmins to support individual and group products.

A second reason large employers that adopt ICHRAs will not move away from BenAdmins is that they want to keep certain products (e.g., group life and disability) on the group “chassis.” This, too, requires BenAdmins to support both individual and group products.

All of which suggests a three-point game plan for BenAdmins to remain competitive in an ICHRA world:

  1. Support both individual- and group-plan comparison. BenAdmins must be able to support a hybrid individual and group plan comparison experience. For instance: group health and ancillary for some employees but individual health and group ancillary for other employees. And unlike the group market, where a typical employee may choose from a handful of medical plans that are fairly easily configurable, tens (if not hundreds) of plans may be available and will therefore need to be configured.  
  2. Support both individual- and group-plan decision support. Accounting for tens (or hundreds) of medical plans exacerbates the complexity of plan choice by each employee. So BenAdmins must shepherd employees through the decision process with the appropriate tools and features. What was once optional (shop-by-doc, shop-by-drug) is now table stakes. 
  3. Support both individual- and group-enrollment and eligibility changes. Only offering plan selection during open-enrollment period (OEP) is not enough. BenAdmins will need to support individual enrollment, demographic changes, QLEs, etc. for individual products. This represents a whole new integration challenge for BenAdmins.

Bottom line: ICHRAs are an opportunity

ICHRAs do not spell the end of benefit administration— at least not with larger employers. But BenAdmins will need to enhance their platforms to support this new and important coverage option. And in doing so, they will set themselves apart from competitors who disregard a coverage option that could become as ubiquitous as 401(k)s.

If you’re interested in reading more of Ideon’s 2021 ICHRA research and learning how APIs can streamline the development of ICHRA solutions, download our full-length ICHRA toolkit.